Department of Paediatrics

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    Open Access
    Acute bacterial meningitis in a developing country: diagnosis related mortality among paediatric patients
    (University of Zimbabwe Publications, 1998-01) Imananagha, K.K.; Peters, E.J.; Philip-Ephraim, E.E.; Ekott, J.U.; Imananagha, L.N.; Ekure, E.N.; Esin, R.A.
    OBJECTIVES: To evaluate the effect of late diagnosis and other factors on outcome of paediatric bacterial meningitis (BM) and recommend appropriate intervention. DESIGN: Case series. SETTING: University of Calabar Teaching Hospital, Calabar, Nigeria. SUBJECTS: 62 consecutive BM patients aged two months to 16 years admitted between 1991 and 1994. MAIN OUTCOME MEASURES: Mortality rate. RESULTS: Diagnostic difficulties experienced in 58% of cases and other factors resulted in delayed diagnosis and high mortality (20 to 47%). CONCLUSION: Only elimination of the identified inadequacies in management can significantly reduce the BM-related high mortality in developing countries.
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    Open Access
    Paediatric HIV/AIDS Infection in three of four children from consecutive twins deliveries
    (Paediatric Association of Nigeria, 2000) Ekanem, E.E.; Uniga, A.J.; Ekure, E.N.
    Vertical infection the Human Immunodeficiency Virus (HIV) among two consecutive pair of twins from a well-to-do family is presented. While the first twin of the first pair must have been infected in-utero, the second may have been infected at parturition or through breast milk. Severe protein-energy malnutrition was the main mode of presentation. A recommendation is made for routine screening of pregnant women during ante-natal care with family planning counselling of positive cases. Zidovudine therapy for infected pregnant women is also recommended. In addition, it is suggested that infected mothers from high socio-economic classes in our environment should not breast-feed their infants. HIV/AIDS should please be suspected when PEM manifests in children from high socio-economic families.
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    Open Access
    Perinatal Mortality Among Twins In Lagos University Teaching Hospital : Associated Risk Factors
    (Lagos University Medical Society, 2002) Ekure, E.N.; Iroha, E.O.
    Background: Perinatal mortality rate is reported to be higher in twins than in singletons. More than two decades ago, Abudu and Agarin reported a twinning rate of 21.1/1000 maternities and perinatal mortality rate of 142.6/1000 among twins in Lagos. Objective: To determine the current perinatal mortality rate and risk factors that influence perinatal mortality among twins in Lagos University Teaching Hospital, Nigeria. Materials and Methods: Babies weighing >1000grammes delivered by twin pregnancy between January 1996 and December 2000 in Lagos University Teaching Hospital were retrospectively studied. Routinely collected data from nurses and doctors registers in the departments of Obstetrics and Paediatrics on all twin deliveries was analysed. Results: Out of 5,947 deliveries, there were158 set of twins' giving a twinning rate of 26.6/1000 for the institution. Fifteen of the babies weighed <1000g and so were excluded leaving 301 babies. Twenty-seven babies weighing >1000g died perinatally giving a perinatal mortality rate of 89.7/1000. The significant risk factors for perinatal mortality identified in twins were lack of antenatal care (P=0.005), low gestational age and premature delivery (P<0.005), low birth weight especially <2000g (<0.001), like-sex pair (P=0.01) and breech presentation (P=0.05). Conclusion: All multiple pregnancies should be supervised in institutions with facilities for premature care and babies who weigh <2000g, belong to like-sex pair or have breech presentation should be specially cared for by personnel trained in neonatal care because of a significant risk of perinatal mortality.
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    Open Access
    The impact of an intervention to change health workers' HIV/AIDS attitudes and knowledge in Nigeria: a controlled trial
    (Elsevier, 2002-03) Ezedinachi, E.N.U.; Ross, M.W.; Meremiku, M.; Essien, E.J.; Edem, C.B.; Ekure, E.N.; Ita, O.
    The aim of the study was to improve health workers' skills and confidence in dealing with patients with HIV disease and increase attention to patients' human rights. A longitudinal controlled trial was carried out in which one Nigerian state served as the intervention site and the adjacent state served as the control site for an intervention and dissemination of training in clinical management, health education, and attitudinal change toward patients with HIV disease. The intervention group n=1072, control group n=480. Following initial questionnaire-defining focus groups, nurses, laboratory technologists and physicians in all base hospitals in the intervention state were trained by influential role models who attended the initial training. Data were collected in all sites pre-training and 1 y later. Hierarchical multiple regression analysis controlling for baseline data, and orthogonal factor analysis to define scales were used. Data showed significant positive changes after 1 y in the intervention group on perception of population risk assessment, attitudes and beliefs about people with HIV disease, less fear and more sympathy for and responsibility toward HIV patients, and an increase in self-perceived clinical skills. There was increased willingness to treat and teach colleagues about people with HIV. Clinician fear and discrimination were significantly reduced, and the climate of fear that was associated with HIV was replaced with a professional concern. There was increased understanding of appropriate psychosocial, clinical and human rights issues associated with HIV treatment and prevention. This intervention, targeting health workers in an entire state and using HIV/AIDS information, role modeling, diffusion of training and discussions of discrimination and human rights, significantly affected the perception of risk groups and behaviors, perceived skills in treatment and counseling, reduced fears and increased concern for people with HIV disease, and improved the climate of treatment and prevention of HIV disease compared with a control state.
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    Open Access
    Factors influencing HIV seroprevalence rate among pregnant women in Calabar, Nigeria
    (Bachudo Science Company Limited, 2003) Ekure, E.N.; Etuk, S.J.
    Human immune deficiency virus (HIV) seroprevalence among pregnant women in Calabar was studied. The aims were to establish HIV seroprevalence rate and to identify factors which influence this rate in our pregnant women. HIV seroprevalence rate of 2.7% among antenatal women in Calabar was recorded with a vertical transmission rate of 20%. Husband and wife not living together, history of induced abortion and blood transfusion significantly increase HIV seroprevalence rate among antenatal women in our community (P = 0.02 - 0.04). Marital status and age seemed to increase while social class and previous pregnancy outcome did not influence the HIV seroprevalence rate in these women. The importance of screening as a necessary step towards prevention of vertical transmission should be emphasised during our antenatal health talks. Pregnant women with history of induced abortion, those who are not living together with their husbands and those with history of blood transfusion should have a one-to-one person education on this issue. Any cause that would separate wives from their husbands should be discouraged. Family planning as a means of preventing unwanted pregnancy should be encouraged and transfusion of unscreened blood should be banned in all health facilities in Nigeria.
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    Open Access
    Maternal Exclusive Breast- Feeding Practice In Calabar, Nigeria: Some Related Social Characteristics
    (Medical and Dental Consultants' Association of Nigeria, 2003) Ekure, E.N.; Antia-Obong, O.E.; Udo, J.J.; Edet, E.E.
    Objective: To determine the social characteristic of mother who practice exclusive breast –feeding in Calabar Subject and Methods: A prospective questionnaire based cross sectional survey of breast feeding practices among mother of children aged 0-24 months was carried out in Calabar in April 1998. Using WHO indicators for assessing breast feeding practices, the exclusive breast feeding rate was determined in mothers of children aged 0-6 months. This documents the social characteristics of those mothers who practiced exclusive breast feeding (EBF). Result: Of 1145 mother in the study, 4456 were mothers of children aged 0-6 months. Of this 102 (22.9%) practiced EBF. The maternal characteristics associated with a high EBF rate were being married (p<0.01), attainment higher education (p<0.05%), the use of health facility based ante natal care (p=0.001) and delivery services (p<0.00000001). Other were paid employment with maternity leave (p<0.001) and being of Cross River state extraction (p<0.01). Parity did not appear to influence EBF (p>0.2) Conclusion: This study has shown that being married, attaining higher education, being on paid maternity leave, use of government health facility based ante natal and delivery services as well as being of Cross River state extraction were maternal characteristics associated with EBF. There is need to intensity health education on the benefits and management of breast feeding in order to improve the present EBF rate of 22.9%.
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    Open Access
    Perinatal Mortality at the Close of the 20th Century in Lagos University Teaching Hospital
    (Paediatric Association of Nigeria, 2004) Ekure, E.N.; Iroha, E.O.; Ogedengbe, O.K.; Egri-Okwaji, M.T.
    Objective: To determine the perinatal mortality rate in Lagos University Teaching Hospital at the close of the 20th century. Materials and Methods: Routinely collected data from the Departments of Obstetrics & Gynaecology and Paediatrics from January 1996 to December 2000, were analysed. The data included total deliveries, stillbirths and early neonatal deaths. Results: A total of 6,759 deliveries, including 163 multiple pregnancies, occurred during the period. There were 573 perinatal deaths comprising 471(69.7/1000) stillbirths and 102(16.2/1000) early neonatal deaths. Autopsy was performed on 115 of the 573 deaths resulting in a perinatal autopsy rate of 20.1 percent. The overall perinatal mortality rate was 84.8/1000 while the perinatal mortality rate for singletons was 83/1000. Analysis of the deaths by the Wigglesworth classification showed that 46.6 percent of the deaths were normally formed macerated stillbirths, 38.7 percent were due to asphyxial conditions and 8.9 percent were attributed to conditions associated with immaturity. Lethal congenital malformations accounted for 3.7 percent while other specific conditions were responsible for 2.1 percent of the deaths. Conclusion: These rates are still very high and strategies to decrease perinatal mortality will need to focus on antenatal and intrapartum obstetric care. All those involved in obstetric and neonatal care require regular education on the need for prompt identification of problems, early referral and prompt intervention.
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    Open Access
    Urethral Prolapse in a Five-year-old Girl
    (2004) Ekure, E.N.; Okoromah, C.N.; Afolabi, B.B.; Okechukwu, S.E.
    Urethral prolapse is a rare cause of vaginal bleeding in prepubertal females and occurs most commonly in black people. It is characterized by a sliding outward of the urethral mucosa around the entire urethral meatus. Because it can present with vaginal bleeding in a child, it can be mistaken for sexual abuse. We report a five-year-old girl with urethral prolapse that was mistaken for complications of sexual abuse. She was treated by complete excision of the urethral prolapse with satisfactory result.
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    Open Access
    Holt-Oram syndrome with hypoplastic left heart syndrome in an African child
    (National Postgraduate Medical College of Nigeria, 2004-09) Ekure, E.N.; Okoromah, C.N.; Briggs, E.; Ajenifuja, O.A.
    This report illustrates the rare association of Holt-Oram syndrome with hypoplastic left heart syndrome hitherto unreported in an African child. The above association is highlighted as this child and the only other case reported in a Caucasian were diagnosed post mortem. The need for early cardiovascular and genetic evaluation or simple detailed family history to aid counselling is also emphasised.
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    Open Access
    Outcome of low birth weight neonates in a tertiary health care centre in Lagos, Nigeria
    (College of Medicine, University of Ibadan, Nigeria, 2004-12) Ezeaka, V.C.; Ekure, E.N.; Iroha, E.O.; Egri-Okwaji, M.T.
    The records of all low birth weight (LBW) neonates admitted into the Neonatal Unit of the Lagos University Teaching Hospital (LUTH) from January 1997 to December 2001 were retrospectively analysed in order to determine the outcome and risk factors associated with mortality. There were 535 LBW admissions of which 411(76.8%) survived while 124(23.2%) died. The birth weight specific mortality rate for the < 1000g neonates was 818 per 1000, 451 per 1000 for the 1000-1499g, 216 per 1000 for the 1500-1999g, and 67 per 1000 for the 2000-2499g neonates (X2 = 127.70, p = 0.0001). Primary indications for admission were neonatal sepsis (25.2%), perinatal asphyxia (23.0%) and neonatal jaundice (19.6%) with case fatality rates of 20.0%, 34.1% and 10.5% respectively (X2 = 34.24, p = 0.00001). Death occurred within 48 hours of admission in 45.2% of subjects and by the 7th day, 72.6% had died (X2 = 70.07, p = 0.0001). Significant risk factors associated with mortality were birth weight [OR 4.24, 95% CI = 3.14-5.72] and category of LBW [OR 2.79, 95% CI = 1.65-4.69]. Sex, twinning, booking status and mode of delivery had no significant influence on mortality. Since the provision of adequate intensive care for these vulnerable infants remains a major challenge in countries with poor resources, efforts should be intensified to implement effective strategies for the reduction of low birth weight deliveries.
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    Open Access
    Neonatal Mortality of Inborns in the Neonatal Unit of a Tertiary Centre in Lagos, Nigeria
    (Lagos University Medical Society, 2005) Ekure, E.N.; Ezeaka, V.C.; Iroha, E.O.; Egri-Okwaji, M.T.
    Background: Neonatal mortality is a useful index of assessing the socioeconomic development of an area. Its periodic evaluation is therefore a necessary and valuable audit index of the care given. The aim of this study is to document the neonatal mortality rate of inborn babies at Lagos University Teaching Hospital (LUTH) and describe the pattern of these deaths. Study Design: In-born neonatal admissions at the LUTH over a five-year period (January 1996 – December 2000) were retrospectively reviewed. Data on mortality, pregnancy, delivery and neonatal indices were extracted from ward records. Results: There were a total of 6,272 live births of whom 2,496 (39.8%) were admitted into the neonatal unit. One hundred and forty one of the neonates died giving a mortality rate of 22.5/1000. The neonatal deaths comprised of 120 early neonatal deaths and 39 late neonatal deaths. The yearly neonatal mortality rate showed a steady decline except for 1999 during which there was a slight rise. The incidence of neonatal deaths decreased with age, weight at birth and maturity. Low birth weight and birth asphyxia were the leading associated causes of death. Complications of pregnancy occurred in 45.4% of the mothers of these neonates with pregnancy induced hypertension as the most prevalent (62.5%). Conclusion: An overall inborn neonatal mortality rate of 22.5/1000 in our institution is still high but a declining trend is portrayed and will be further improved with the institution of measures to control or reduce the incidence of pregnancy induced hypertension, low birth weight and birth asphyxia.
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    Open Access
    A Review of 10 Years Autopsy of children with Cardiovascular Disorders
    (Wolters Kluwer Medknow Publications, 2005) Ekure, E.N.; Abdulkareem, FB
    Objectives: To review the prevalence and pattern of cardiovascular disorders in childhood autopsies in Lagos University Teaching Hospital (LUTH). To also determine the frequency of associated extra cardiac complications and characteristics of children with cardiovascular diseases that died. Materials and Methods: The autopsy register of the department of Morbid anatomy for the years 1991 to 2000 in LUTH was retrospectively reviewed. Data extracted including age, sex, primary diagnosis and cause of death was obtained for children aged less than 18years and analysed using SPSS 11.0 software. Results: Cardiovascular disorder was found in 93 of 2,032 autopsies (4.6%) done on children in LUTH for the study period. Sixty nine (74.1%) of the cardiovascular disorders were congenital heart diseases while 22 (23.7%) were acquired heart diseases. The commonest acyanotic and cyanotic congenital heart diseases were ventricular septal defect and tetralogy of fallot respectively. Rheumatic heart disease was the predominant acquired heart disease. The peak incidence was in the neonatal period with 31 (33.3%) neonates. There were extra cardiac complications in 23% of cases. These mostly involved the respiratory and central nervous system with bronchopneumonia being the commonest non-cardiac complication. The primary cause of death for 70 (75.3%) of them was cardiac failure. Conclusion: Majority of children with cardiovascular diseases die in the neonatal period making cardiac diseases one of the contributions to neonatal deaths. Early diagnosis, appropriate medical management and surgical intervention will help prevent these deaths thereby reducing neonatal and child mortality.
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    Open Access
    Non-traumatic paraplegia in Nigerian children presenting at the University College Hospital, Ibadan
    (African Journal of Medicine and Medical Sciences, 2006-03) Fatunde, O.J; Lagunju, I.A; Adeniyi, O.F; Orimadegun, A.E
    A review of the presentation, management and outcome in all children presenting with non-traumatic paraplegia managed by the paediatric neurology team at the University College Hospital Ibadan, Nigeria from June 1989 to May 2004 is presented. Of the 110 patients, there were 54 males and 56 females giving a M:F ratio of 1:1. The mean age of the group was 5.3 (SD = 3.1) years, with a range from 9 months to 11 years. Infections and infectious processes caused the paraplegia in 102 (92.7%) of the cases with poliomyelitis and tuberculosis (TB) of the spine accounting for 88 (80%) of cases. The study period was divided into three 5 year periods. While poliomyelitis was the commonest cause of paraplegia (60%) in the first 5 years: TB spine was responsible for most cases (40%) in the last 5-year period of the study. There was a significant reduction in the total number of cases seen when the initial 5-year period was compared with the last (45 and 26 respectively, P = 0.001). Overall mortality among the 110 admitted patients was 7.2% being highest (50%) in malignant disorders and none was recorded in TB spine. Prognosis for eventual ability to walk was best in cases of TB spine where 37 of the 39 patients (95%) were ambulant by discharge after 60 days of anti-TB treatment. The 2 non-ambulant patients eventually walked within 3 months of discharge while on maintenance treatment for TB. Only 2 of the 51 non-ambulant patients obtained wheelchairs at discharge. The implications of inadequate facilities for investigation and treatment as well as the lack of financial and social support for the families of affected children are discussed.
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    Open Access
    Prevalence of iron deficiency in children 6-24 months in Lagos.
    (2007-07) Fajolu, I.B.; Grange, O. A.; Renner, J.K.; Odunukwe, N.W.; Njokanma, O.F.; Ahmed, O.A.; Efenemokwu, C.
    BACKGROUND: Iron deficiency is the commonest cause of nutritional anaemia in children worldwide particularly in developing countries. Infants and toddlers are prone to developing iron deficiency anaemia (IDA). This study was carried out to determine the prevalence of IDA and some factors associated with it in this group of children. STUDY DESIGN: Haemoglobin concentration and mean corpuscular volume (MCV) estimations carried out in 282 apparently well children aged 6-24 months. Estimations of serum iron (SI), total iron binding capacity (TIBC), serum ferritin (SF) and transferrin saturation (TS) were also determined in children with anaemia (Hb concentration < 11.0 g/dl). Information on current diet was also obtained using a diet record. RESULTS: Two hundred and twenty three (79.1%) children had anaemia. The mean Hb concentrations of all the age groups were less than 11.0 g/dl. Forty (14.9%) children had IDA (defined as aneamia plus 2 or more of the following--MCV < 70fl, Ts < 10% or SF < 10 microg/dL). The mean age of children with IDA (8.96 +/- 2.54 months) was statistically lower than for those without the condition 10.94 +/- 4.55 months (p = 0.016). Inclusion of vegetables and animal protein less than three times a week in the diet were both significantly associated with IDA. CONCLUSION: The prevalence of IDA in this study is high especially before the age of 12 months and an average weekly intake less than 3 times a week or iron rich foods like animal protein and vegetables was significantly associated with IDA. Emphasis should be on the inclusion of iron rich foods in the diet following exclusive breastfeeding to reduce the prevalence of IDA in these children.
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    Open Access
    Structural heart disease in children in Lagos: profile, problems and prospects
    (National Postgraduate Medical College of Nigeria, 2008-06) Okoromah, C.A.; Ekure, E.N.; Ojo, O.O.; Animasahun, B.A.; Bastos, M.I.
    OBJECTIVES: Structural heart disease (SHD) contributes significantly to the health burden of children in Nigeria, unfortunately comprehensive cardiovascular programme including definitive surgery is currently not available locally. This may have contributed to the paucity of research in paediatric cardiology. Available epidemiologic data are limited and mostly outdated. We studied the current distribution SHD in Lagos and compared findings with reports elsewhere. Problems and prospects associated with cardiovascular care at the study site were highlighted. MATERIALS AND METHODS: Children referred from public and private health facilities for cardiovascular evaluation including echocardiography between January 2004 and December 2005 were studied. PDA in premature babies, PFO and post surgical SHD were excluded. Proportions and relative frequencies of different heart lesions were calculated and analysed using appropriate statistics. RESULTS: Congenital heart disease (CHD) significantly outnumbered acquired heart disease (AHD) (p=0.0001) in these children aged 4 weeks to 15 years (mean age = 3.8 +/- 2.5 years); the relative frequencies were VSD (41.7%), VSD (41.7%), ASD (20.2%), TOF (11.8%), AVCD/ECD (7.0%), PDA (5.7%), PS (3.1%), single ventricle and TGA (2.2%) each. PS was dominant in males, while septation defects were dominant in females. Pericarditis with effusion (31%), RHD (28.6%), myocarditis (14.3%) and dilated cardiomyopathy (14.3%) were the commonest AHD. CONCLUSION: Contrary to previous hospital reports CHD rather than RHD and other AHD are dominant in some African settings like Lagos, and their relative frequencies are similar to reports elsewhere. The wide range of children with diverse native CHD is a reflection of non-availability of definitive surgical facilities locally. Regional and International collaboration could be mutually beneficial.
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    Open Access
    Sporadic emergence of probable cases of diphtheria
    (2009) Fajolu, I.B.; Temiye, E.O.; Egri-Okwaji, M.T.C.
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    Open Access
    In-hospital outcome of children referred for cardiac surgery abroad from a developing country
    (Paediatric Association of Nigeria, 2009) Ekure, E.N.; Okoromah, C.A.N.
    Background: Cardiac surgery is the definitive intervention for structural heart diseases particularly of congenital aetiology in children. Unfortunately, most developing countries currently lack adequate capacity for paediatric cardiac surgery often necessitating referral to foreign countries with appropriate facilities and capacities. We hereby report the in-hospital outcome of Nigerian children referred from Lagos University Teaching Hospital to undergo cardiac surgery abroad. Methods: Nigerian children referred from the Lagos University Teaching Hospital, Lagos State, to centres abroad for cardiac reviewed Data obtained from records for analysis were sex, pre-surgical diagnosis, age at surgery, year surgery was performed, surgical centre location, post-operative echocardiography report, length of hospital stay and in-hospital case fatality. Results: In the five year period 68 children underwent heart surgery. Age at surgery ranged from 3 months to 14years (mean=41.71±43.88 months) while their average duration of hospital stay was 25 days. The surgeries performed were ligation of patent ductus arteriosus (PDA), repairs of atrial and ventricular septal defects, tetralogy of Fallot, atrioventricular canal defects, arterial switch operations, mitral valve repair and replacement. Three 94.4percent) in-hospital deaths occurred (all in children <2years). Major post operative complications related to death were respiratory problems and low cardiac output state. Conclusion: The in-hospital case fatality rate at 4.4percent is low for Nigerian children undergoing cardiac surgery abroad with low cardiac output state common to all the deaths.
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    Open Access
    Marfan syndrome: a study of a Nigerian family and review of current cardiovascular management
    (West African College of Physicians and West African College of Surgeons, 2009-01) Ekure, E.N.; Onakoya, A.O.; Oke, D.A.
    BACKGROUND: Marfan's syndrome is a connective tissue disorder inherited as an autosomal dominant disorder. It causes a myriad of distinct clinical problems, of which the musculoskeletal, cardiac, and ocular system problems predominate. Nearly 50 percent of patients have to undergo aortic surgery in their lifetime resulting in reconstruction or replacement of the aortic root or total of this vessel's parts. OBJECTIVE: To describe a Nigerian family with multiple cases of Marfan syndrome and discuss current cardiovascular management of the syndrome. MATERIALS: Detailed history, clinical and laboratory investigations including ophthalmologic assessment and echocardiography were carried out on all members of a nuclear family of a child who reported with complaints of poor eye sight later diagnosed to have Marfan syndrome. RESULTS: Diagnosis of Marfan syndrome was made in three members of the nuclear family--a father and his two children following eye examination of one of the children. Afollow up cardiovascular assessment revealed that the father required aortic surgery while the two children also had aortic root dilatation. CONCLUSION: This report underlines the importance of a detailed history, physical examination and family study in patient assessment. Current cardiovascular management in Marfan syndrome involves a blocker therapy and an annual cardiovascular evaluation involving clinical history, examination and echocardiography. Prophylactic aortic surgery should be considered when aortic diameter at the sinus valsalva exceeds 50 mm.
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    Open Access
    Congenital heart diseases associated with identified syndromes and other extra-cardiac congenital malformations in children in Lagos
    (West African College of Physicians and West African College of Surgeons, 2009-01) Ekure, E.N.; Animasahun, A.; Bastos, M.; Ezeaka, V.C.
    BACKGROUND: Congenital heart diseases are commonly associated with other extra cardiac congenital malformations. OBJECTIVE: To identify congenital heart diseases associated with identified syndromes and other extra cardiac congenital malformations in children in our hospital. METHODS: A prospective descriptive study done on children with congenital malformations referred to the Lagos University Teaching Hospital, Nigeria (LUTH) for echocardiographic evaluation. A thorough 2D assessment of the chambers, septa, heart vessels and concordance of the atrium and ventricle and the great vessels was made. Echo-cardiographic data obtained included M mode direct measurements of dimensions of left atrium, aortic root, right ventricular outflow tract, left ventricle in diastole/systole, wall thicknesses--right ventricular wall, interventricular septum, left ventricular posterior wall. Fractional shortening was derived from M mode data. Final diagnosis of the congenital heart disease was recorded. RESULTS: A total of 101 children with congenital malformations had echocardiography studies done as part of their clinical evaluation, 15 (14.9%) were neonates, 53 (52.5%) infants 25 (24.8%) were aged one to five years and 8 (7.9%) were above five years of age. Recognised syndromes were seen in 69 (68%) cases. Down syndrome with 54 children contributed 78.3% of those with known syndromes. Other identified syndromes and associations were Marfan's, Noonan's, Edwards, Prune Belly, Apert, Ellis-van Creveld syndrome and congenital rubella syndrome. Congenital heart diseases were detected in 73 (72.3%) patients while 28 (27.7%) had no heart defect. The commonest identified congenital heart disease was ventricular septal defect affecting 30 (29.7%) patients. CONCLUSION: Congenital heart diseases are common in children with congenital malformations. Down syndrome was the most common malformation and the congenital heart disease most associated with the congenital malformations was ventricular septal defect. This study emphasizes the need for cardiac assessment of children with congenital malformations.
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    Open Access
    Physicians management of sore throat in children in Benin City, Nigeria
    (MedKnow, 2009-12) Sadoh, W.E.; Akinsete, A.M.
    INTRODUCTION: Sorethroat is a common reason for presentation in primary paediatric care. Because only a minority of cases of pharyngitis is caused by bacteria, physicians have been guided by various recommendations on the judicious use of antibiotics to avoid overprescription. In the absence of guidelines, the treatment approaches between physicians may differ. The management of children with sorethroat by physicians in Benin City, Mid-Western Nigeria was evaluated. SUBJECTS AND METHODS: The experience and practice of 25 paediatricians and 30 non paediatricians who routinely attend to children with sorethroat in Benin metropolis, Nigeria were evaluated with the aid of a self administered questionnaire. Information sought for included biodata, empirical antibiotic prescription. The choice of antibiotic and complications ofpharyngitis encountered in practice. RESULTS: Majority of respondents 31(56.4 %) considered viruses as the commonest cause of pharyngitis. Despite this an equal proportion 31(56.4 %) treated children with sorethroat empirically with antibiotics. Of these, significantly more paediatricians 19(61.3 %) than non paediatricians 12(38.7 %) considered viruses the commonest cause of pharyngitis, P = 0.013. CI (0.10 0.63). Almost three quarter (72.7 %) of respondents examine the throat of the children while only 18.2 % obtained throat swab for microbiological analysis. The 24 doctors who did not treat empirically would prescribe antibiotic if the patient has purulent pharyngeal exudates, fever and adenitis. Augmentin and cefuroxime were the most prescribed antibiotics. CONCLUSION: A lot of children served by these doctors receive antibiotic needlessly from empirical antibiotic treatment ofpharyngitis. National guidelines on appropriate antibiotic use is needed to promote rational use of antibiotics and reduce antibiotic overuse